Endovascular repair with a physician-modified fenestrated endograft under 3D image fusion guidance to treat abdominal aortic pseudoaneurysm with Behcet’s disease: a case report

Abstract

Abstract Background Aortic involvement in patients with Behcet’s disease (BD) is rare, but it is one of the most severe manifestations. Open surgical repair of aortic aneurysm is challenging considering the high risk of postoperative recurrent anastomotic pseudoaneurysms and is associated with a much higher mortality rate. Recently, endovascular treatment has provento be a feasible, less invasive alternative to surgery for these patients. Case presentation We report a total endovascular repair of a paravisceral abdominal aortic pseudoaneurysm in a 25-year-old male patient with BD. The pseudoaneurysm was successfully excluded, and the blood supply of visceral arteries was preserved with a physician-modified three-fenestration endograft under 3D image fusion guidance. Immunosuppressive therapy was continued for 1 year postoperatively. At 18 months, the patient was asymptomatic without abdominal pain. Computed tomography angiography demonstrated the absence of pseudoaneurysm recurrence, the antegrade perfusion of visceral vessels, and the absence of stent graft fractures. Conclusions Endovascular repair using physician-modified fenestrated endografts is a relatively safe and effective approach for treating paravisceral abdominal aortic pseudoaneurysm in BD patients. Long-term immunosuppressive therapy is necessary to decrease the risk of postoperative complications and recurrences.